Facilitating change and advocating for interventional radiology in your hospital requires strong communication skills and knowing how to approach hospital administration. However, effective communication, negotiation and consensus-building are not typically taught in medical schools. How can you improve these skills to strive for patient-centered care in your hospital setting?
The ask
“Over the years, I have realized that it gets easier when you are collaborative, when you don’t make it about us versus them,” said Nishita Kothary, MD, FSIR, professor of interventional radiology at Stanford School of Medicine and chair of value-based care and medical co-director for supply chain for Stanford hospitals.
IR leaders must often approach hospital administration for capital expenses such as new equipment, new devices, support to expand services including staff as well as processes that best suit IR workflow. Unfortunately, just asking for money is no longer enough. Before one even approaches administration, the first step is to build a true business case, with a clear visual of their return on investment (ROI).
“You really have to build a logical argument. So, you need to frame the problem. Show the current status quo,” said Kush R. Desai, MD, FSIR, the systemwide medical director for value analysis/supply chain at Northwestern Memorial HealthCare in Chicago. Dr. Desai is also associate professor of radiology and of medicine and surgery.
When it’s a staffing issue, show what you’ve done already with billing and volume, Dr. Desai said. Share any related patient satisfaction issues, such as missed calls and follow-ups, that may be due to overworked staff. Show how additional staff would improve upon all those areas, he said. When asking for new equipment, explain how current equipment is either outdated or how new equipment would increase business or add a new revenue stream.
Dr. Kothary gave examples of capital investments in new technology that Stanford has made over the years, such as new imaging modalities.
“In those situations, you have to make a good business case as to why that equipment’s better,” she said. “When you’re making a business case for a hospital, two things need to come through. First, it has to somehow be better, safer and faster for the patient—that should always be our North Star. The second question the hospital will ask is ‘Will it increase market share?’ That’s what hospitals are always interested in. So, if you have technology that you think will capture more market share, then that’s a good business plan.”
Framing the ask
A “business plan” doesn’t necessarily have to be something an MBA graduate would develop, but it should lay out your case with data to back up your arguments. Your administrative staff or practice business manager may be able to help you develop the plan. And seek out colleagues with experience in advocating to hospital administration to help you formulate your request.
Barry T. Katzen, MD, FSIR, has been working closely with hospital administration for four decades. He is the founder and chief medical executive emeritus of Miami Cardiac & Vascular Institute in Florida, which is a part of Baptist Health South Florida, the largest healthcare organization in the South Florida region. He is also chief medical innovation officer for Baptist Health South Florida.
“One of the things I’ve always done in any interaction—not only in working as an interventional radiologist with the hospital, but also with other physicians—is think about what the other party wants and try and structure win–win situations,” Dr. Katzen said.
Consider the current economic and hospital environment, too. “You have to really assess the landscape, sense the character of the people that you’re dealing with, and do all that yourself … and that takes time,” Dr. Katzen said.
Frame the “ask” as part of something bigger, he explained, which could be increased profit, an innovative new procedure the hospital can market and/or a benefit to multiple specialties and departments. Don’t shape your argument as something that benefits only you as a physician.
“I never make the ask upfront,” Dr. Katzen said. “I always tell a story.” Explain why something is needed and then walk the administrator through the clinical problem, the unmet need and the potential benefits. Only then, make your request.
Dr. Katzen provided a few examples of what to say:
- “There are these new applications that are developing.”
- “There’s a new technology on the horizon that we need to be planning for.”
- “There’s a new program that could benefit more patients that we’re not treating now.”
- “We have a new way of treating something that could move things to the ambulatory space.”
Using communication strategies
Dr. Katzen’s method aligns with recommendations from communications experts. Present your case with a “think, feel, do” approach, said Lia LoBello Reynolds, founder and owner of strategic communication and consulting agency ofDC Communications.
She explained how the approach works: “This is what I want people to think when I tell them about this, this is what I want them to feel when I tell them this about this, and this is what I want them to do.”
However, it can be human nature to jump straight to the “do” portion: “‘I just want someone to write me the check. I just want someone to say yes to my idea.’ It’s easy to forget about what you want them to think and feel: ‘I want them to think that this is a great idea. I want them to feel excited at what I’m bringing to the table,’” LoBello Reynolds said.
At the same time, don’t make your presentation overly scientific or technical. Don’t present all the studies supporting the value of a piece of equipment or the full details on how it works. Save that information for follow-up questions.
“We need to think about retention of a message,” LoBello Reynolds said. “No one’s going to memorize three pages of literature, but they will remember, ‘Here’s the value proposition, and here are the three points they made that helped me understand it.’ So, keep it simple.”
Dr. Desai recommends practicing your presentation several times before you make your case.
“Rehearse it in your own head to polish your delivery, especially if you’re getting time with a very high-level administrative executive, where your time is going to be limited and your delivery is probably going to be judged, whether you like it or not,” he said. “You can’t come in and be tangential and all over the place with how you present your argument. It has to be linear and logical.”
In addition, keep in mind that whoever you’re making your pitch to likely needs to present your idea to other key decision-makers.
“Knowing what the people who greenlight your projects care about will go a long way to making sure those projects do get approved,” LoBello Reynolds said. “That will help you craft your follow-up email, proposal or memo just a little bit differently because you’ll know how they’ll present it when they slide it across the desk to someone else.”
Getting buy-in from other physicians, especially in other specialties, can also be helpful. “The more you can work collaboratively, the better it is,” Dr. Kothary said. “You’d be amazed how sometimes working with, for example, vascular surgery to request a device that you want means both of you will get that device. Use your colleagues as another way to boost your ask.”
These alliances will also help you present a better narrative and demonstrate more opportunities for the hospital to grow and increase revenues.
“The more you can show those concentric circles out from your project and how everyone can clip into its success, the easier it is to craft the story around why it makes sense,” LoBello Reynolds said. “Let’s say it is an innovative new technology that’s going to be very different for your area. The more people who can say, ‘We were a part of that process,’ and claim it as a win for themselves as well, the more likely you are to get the ‘yes’ that you’re looking for.”
Behaviors to avoid
While developing communication, presentation and negotiation skills takes time—and often only gets better with practice—there are some hard-and-fast rules of what not to do.
Dr. Katzen has witnessed plenty of examples of colleagues not making progress in talks with hospital administrators. Sometimes they don’t make the patient or business case, but instead align it with their personal goals. Other times their approach is not planned out in a methodical way.
One of the more serious mistakes is to take a “no” personally and lose your cool. “Temper tantrums are always a bad idea,” Dr. Kothary said.
Physician–administrator relationships can sometimes be seen as adversarial, Dr. Desai said. Physicians may feel like they’re simply receiving edicts from on high, but hanging onto these preconceived notions is not helpful. It’s always important to try to see the administrator’s viewpoint, even if you disagree or the conversation becomes contentious.
“Being adversarial in your tone and your approach is not going to work,” he said. “Being noncordial is not going to work. How you comport yourself is critically important. Being very level-headed when having these discussions—and being prepared for hearing what you don’t want to hear and processing it—is key.”
Conclusion
IRs are change agents, Dr. Katzen said, so they will frequently need to make the case for new procedures, applications and technology. “As interventionalists, we’re always coming with something new to hospital administration,” he said. “So the more thought out, the better.”
While these skills are not usually a part of the medical school curriculum, they are something IRs can develop and improve on over time. “This is a skill set that we were not trained for but is important,” Dr. Desai said. “The move to value-based medicine is here, and this is very much squarely in the art of medicine now.”
